超声引导下经皮肾穿刺活检术后血肿发生的相关影响因素分析
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摘要
目的探讨多种不同因素对超声引导下经皮肾穿刺活检术后肾周及肾包膜下血肿发生的影响,以减少术后血肿的产生。方法收集于我院接受超声引导下经皮肾穿刺活检术患者155例,术后2d进行超声检查是否有肾周及肾包膜下血肿发生,记录患者能否配合操作、肾脏深度、肾脏大小、肾下极厚度、肾下极皮质厚度、穿刺针数、穿刺用时等,研究以上多种不同因素对肾穿刺活检术后血肿发生的影响。结果根据穿刺术后是否出现肾周及肾包膜下血肿将患者分为有血肿组和无血肿组,两组对比有血肿组肾脏深度小于无血肿组[(26.5±7.2)mm对(29.5±8.5)mm],33例患者不能配合操作,比能配合操作的患者更容易发生血肿(87.9%对37.7%),差异有统计学意义(P=0.02,P<0.001)。穿刺针数、穿刺用时、肾脏大小、肾下极厚度、肾下极皮质厚度两组间差异无统计学意义(P均>0.05)。结论超声引导下经皮肾穿刺活检术是诊断肾脏疾病的重要方法,不同的因素会影响穿刺术后肾周及肾包膜下血肿的发生。肾穿刺术后血肿的发生与患者肾脏深度及能否配合操作有关,穿刺术前训练患者呼吸配合操作、术后腹带或沙袋加压可以减少血肿的发生。
Objective To discuss the different factors effected on hematoma following percutaneous renal biopsy guided by ul-trasound and to provide guidance for the operation. Methods Totally 155 patients who had an indication undergone percutaneousrenal biopsy under ultrasound guidance in our hospital from January 2018 to June 2018 were enrolled in this study. Patients wereobserved by ultrasound if there were perirenal hematoma 2 days after the renal biopsy. The different factors effected the hematomawere taken a statistical analysis. Results All the 155 patients obtained enough specimens and the success rate of renal biopsy was100%. Perirenal hematoma happened in 75 cases(48.4%) after renal biopsy,while 80 cases had no hematoma(51.6%). There wasa statistically significant difference between the two groups in the depth of the renal and patients can cooperate the operation ornot(P=0.02,P<0.001). There was no statistical difference between the two groups in other factors(P>0.05). Conclusion The per-cutaneous renal biopsy under ultrasound guidance is an important diagnostic method in the patients with renal disease. Many fac-tors can affect the hematoma after the renal biopsy,especially the depth of renal and the patients can cooperate with the operationor not.
Objective To discuss the different factors effected on hematoma following percutaneous renal biopsy guided by ul-trasound and to provide guidance for the operation. Methods Totally 155 patients who had an indication undergone percutaneousrenal biopsy under ultrasound guidance in our hospital from January 2018 to June 2018 were enrolled in this study. Patients wereobserved by ultrasound if there were perirenal hematoma 2 days after the renal biopsy. The different factors effected the hematomawere taken a statistical analysis. Results All the 155 patients obtained enough specimens and the success rate of renal biopsy was100%. Perirenal hematoma happened in 75 cases(48.4%) after renal biopsy,while 80 cases had no hematoma(51.6%). There wasa statistically significant difference between the two groups in the depth of the renal and patients can cooperate the operation ornot(P=0.02,P<0.001). There was no statistical difference between the two groups in other factors(P>0.05). Conclusion The per-cutaneous renal biopsy under ultrasound guidance is an important diagnostic method in the patients with renal disease. Many fac-tors can affect the hematoma after the renal biopsy,especially the depth of renal and the patients can cooperate with the operationor not.
引文
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[10]林新广,时红娟,耿云,等.超声引导实时监控下经皮肾穿刺活检149例分析[J].中国中西医结合肾病杂志,2016,17(7):624-625.
[11]陈大卫,温浩茂,韦晓曦. 142例超声引导下经皮肾穿刺活检成功率的对比分析[J].齐齐哈尔医学院学报,2014,35(10):1424-1426.
[12]华锦程,许树根,胡玉清,等.老年肾病患者经皮肾穿刺活检术的临床病理分析及安全性评估[J].东南国防医药,2017,19(4):361-364.
[13]柳刚,陈利民,贺军,等.肾穿刺活检术后灰阶超声与超声造影监测的对比研究[J].中国中西医结合肾病杂志,2013,14(6):522-523,571.
[2]章江川,陈帮明. B超导向经皮穿刺肾囊肿硬化术应用体会[J].江西医药,2012,47(3):235-236.
[3]曾晓春,徐达津,赵红.彩超引导下经皮肾穿刺造瘘术的临床应用[J].江西医药,2011,46(7):664-665.
[4]Pokhrel A,Agrawal RK,Baral A,et al. Percutaneous Renal Biopsy:Comparison of Blind and Real-time Ultrasound Guided Technique[J]. J Nepal Health Res Counc,2018,16(1):66-72.
[5]Zvavanjanja RC,Ashton AS. Page kidney secondary to subcapsularhematoma following percutaneous renal allograft biopsy[J]. RadiolCase Rep,2018,13(3):702-708.
[6]何颖倩,杨亚汝,张会萍,等. CEUS诊断及动态随访经皮肾穿刺后活动性出血[J].中国医学影像技术,2016,32(3):421-424.
[7]吴曙军,刘宁军,朱蕴秋.超声体表定位经皮肾穿刺活检术后并发症[J].中国介入影像与治疗学,2012,9(11):837-838.
[8]程瑞洪,简讯,李斌,等.经皮肾穿刺活检的超声引导技巧研究(附846例分析)[J].四川医学,2014,35(3):290-292.
[9]张忱,邵月凤,张敏,等.实时超声引导下肾穿刺活检术的临床应用[J].中国实用医药,2013,8(31):75.
[10]林新广,时红娟,耿云,等.超声引导实时监控下经皮肾穿刺活检149例分析[J].中国中西医结合肾病杂志,2016,17(7):624-625.
[11]陈大卫,温浩茂,韦晓曦. 142例超声引导下经皮肾穿刺活检成功率的对比分析[J].齐齐哈尔医学院学报,2014,35(10):1424-1426.
[12]华锦程,许树根,胡玉清,等.老年肾病患者经皮肾穿刺活检术的临床病理分析及安全性评估[J].东南国防医药,2017,19(4):361-364.
[13]柳刚,陈利民,贺军,等.肾穿刺活检术后灰阶超声与超声造影监测的对比研究[J].中国中西医结合肾病杂志,2013,14(6):522-523,571.